Complaint Investigation Report

390305107-2-14-2024-27-AS-KHOS-D33V7B-20240305151053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO SOUTH ASC , 9835 GOETHE ROAD, SUITE 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

02/09/2024 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20240209162801

Staff placed client in the wrong transportation bus

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to open and deliver complaint findings for the above allegations. LPA was greeted by staff spoke to administrator on the phone. LPA explained the reason for the visit.

Based on documents reviewed, interviews with facility staff and administrator. The above allegation is SUBSTANTIATED A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. This poses a potential health, safety, and personal rights risk to residents in care.

California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099-D.

LPA exit review: 9099 , 9099-D and appeal rights given.